The unbearable pain of being

By Julie-Anne DaviesMay 31 2002

Australia' s pro-euthanasia movement may have gained another martyr with the semi-public suicide 10 days ago of Gold Coast woman Nancy Crick, but has its image been damaged by news that Crick was not terminally ill? Certainly, the movement itself is divided over whether it picked the wrong person in Crick as its latest public face.

The more conservative elements argue that events in Queensland have been a public relations disaster.

Dr Rodney Syme, president of the Voluntary Euthanasia Society of Victorian, says Crick was not the ideal person to promote the cause of euthanasia.

He and many others in the movement agree that the furore surrounding Crick's case would not have happened if the public had been told the full story. It is the perceived deception that has created the problem, not whether she was dying of cancer or living an unbearable life.

"I don't think it was sensible not to have made it obvious to the public that Mrs Crick did not have cancer but rather intolerable suffering," Syme says.");document.write("

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Nonetheless, despite disagreement over tactics, Syme emphasises that the movement as a whole has never believed that terminal illness is the sole requirement for euthanasia. "A time frame should not be imposed on suffering; we say that hopeless suffering is the criteria that euthanasia should be measured against."

But is the euthanasia movement redefining the boundaries ahead of public understanding of the issue? Many people who supported Crick's right to die only held that view because they believed she was dying of cancer. When news emerged earlier this week that Crick was cancer free - a fact the Queensland coroner has not yet confirmed - many supporters began reassessing their position.

David Kissane, professor of palliative care at Melbourne University and a psychiatrist who works with cancer sufferers, is in no doubt. He calls it the slippery slope phenomenon, where one day the public believes they are supporting the rights of the terminally ill to die with assistance only to discover the euthanasia advocates have shifted the goal posts to include what they term the "hopelessly ill".

"The euthanasia movement denies the slippery slope argument, they say it won't happen. But we've just seen, in real time, precisely that happen with Nancy Crick," Kissane says. "And as a result, they've damaged their own cause."

A fierce opponent of euthanasia, Kissane argues that euthanasia in itself is harmful to society in that it weakens, and lowers the quality of, the practice of medicine.

He wonders whether the 21 witnesses to Crick's death knew she was not dying from bowel cancer. He also claims that doctors who support people who want to suicide could be failing in their duty of care by not providing the type of medical treatment to prevent their patients carrying out their threats to kill themselves.

A recent case in Holland illustrates his concerns. There, a 52-year-old woman suffering from deep depression after the death of her two children, requested and received euthanasia. The Dutch courts then examined the case and judged that depression was a valid form of suffering and accepted the decision of the doctors to help the woman die.

"This is where we head when we start accepting that people with chronic conditions are candidates for euthanasia," Kissane says.

Crick's own website, which has logged more than 400 messages since her death, reflects the divisions within the community.

"It sounds to me, that for whatever reason, she did not receive the best treatment," one correspondent wrote earlier this week. "I did not hear any mention of her being under any doctor except when she went to the palliative care unit - which also apparently didn't investigate the true cause of her pain."

But overwhelmingly, most people who have sent e-mails to the site support Crick's decision, regardless of what, in the end, made her choose to die. A number of messages tell stories like this.

"I would like to say that I truly admire you Nancy and all your family for sticking by you. When I was younger my nanna killed herself with weed poisoning of all things as she couldn't get the help from anyone. She died alone and in pain and her family had to find her and clean up the mess and deal with her death in that horrible way."

Dr Philip Nitschke, a Crick supporter and head of the more radical Exit Australia, has confirmed that Crick had been told repeatedly by medical specialists months before she took her life that she was no longer terminally ill from cancer. Crick, however, never made public the diagnosis and did not tell her family she was no longer suffering from bowel cancer.

But Nitschke recalls that during one consultation he attended, a palliative care specialist told Crick that she was ill enough to be considered terminal.

"A palliative care doctor said to Nancy, `Well, we don't know what you've got, but if you are suffering so badly that you want to take your life, of course you are terminal'."

In hindsight, Nitschke says , he should have made her medical condition clearer to the public. However, the revelation that Crick did not have cancer at the time of her death should not reflect poorly on the pro-euthanasia campaign. He says Crick knew what her condition was and still decided her quality of life was so poor she wanted to take her life.

Crick's family have voiced their own concerns over the controversy surrounding her death and issued a statement earlier this week: "We are saddened that her death is surrounded in such controversy. She was not manipulated or a fool, rather a woman who knew exactly what she wanted and set out to get it. Those suggesting otherwise simply did not know her."As far as Nitschke and his supporters are concerned, this is where the issue should rest.

John Edge, the Queensland head of Exit Australia, who was present when Crick died, says the current debate is being fuelled by right to life proponents and suggests that the leaks out of the coroner's office have been politically motivated. "The coroner himself rang the Crick family to assure them that he did not know the source of the leaks and was embarrassed by such information getting out. We're in a trough at the moment but it is entirely political . . . we've got to expect a few broadsides along the way from our opponents," Edge says.

Prahran GP Darren Russell was one of seven doctors who, in 1995, signed a letter published in The Age supporting euthanasia. A public furore quickly unfolded and for a time at least, it seemed there might be some easing of existing laws.

The short-lived Northern Territory legislation (which allowed euthanasia under certain conditions but was overturned by the Federal Government within 12 months) was enacted the same year. Under those laws seven people died. Seven years on, Russell says it is a measure of how little change has occurred in the intervening years that public stunts such as Crick's suicide take place.

"I suppose what's happening is that people are becoming increasingly disheartened that there hasn't been any law reform despite the fact that an overwhelming majority of people want reform in this area," Russell argues.

"Campaigns in the past haven't been effective, so something different is needed. So, I think, if people are brave enough to face public scrutiny about this, I think that would probably assist in (getting) new legislation."

Russell says even if the coroner finds Crick did not have cancer when she died, it would not harm the pro-euthanasia campaign.

"The issue is suffering, that's the issue."

Russell, who specialises in the treatment of HIV and AIDS, says that although there are fewer deaths from AIDS now than a decade ago because of better drug treatments, he still helps people to die.

"It's a fairly standard thing. Just because it's not in the media all the time, it doesn't mean that it's not happening. It still goes on."

Underground euthanasia is a public health problem that neither the medical profession nor politicians will confront, says Roger Magnusson, a senior lecturer in law at Sydney University and the author of Angels of Death, an investigation into the pro-euthanasia underground.

"You can hardly blame the euthanasia movement for adopting more risky strategies in an effort to bring the issue to the public's attention," Magnusson says.

"They are driven to this because the politicians run scared and the doctors won't face up to it."

Magnusson worries that by using people such as Nancy Crick as "mascots" for the euthanasia cause, advocates like Nitschke and Edge leave themselves open to accusations of exploitation.

He wonders, too, whether the publicity that necessarily follows public disclosure can give desperately ill people a new will to live, but forces them into a position of either seeming to back down on their stated intention to suicide or compels them to go ahead but with doubts.

"In Nancy Crick's case, she seemed to set a date and then step back from the precipice. When this happens the euthanasia movement looks silly and worse, the public sees the hand of the euthanasia advocate on the shoulder of the sick person and that is unseemly."